Lenalidomide Early Intervention in High-Risk CLL | Kerry Rogers, MD | ASH 2023

Hi, I'm Carrie Rogers. I'm a hematologist at The Ohio State University and an associate professor in the division of hematology. And I'm here at ASH 2023 and I'm excited to share with you some results of some research I presented here at this meeting. So as many people may know, there's a drug called lenalidomide that actually is commonly used in cancers like multiple myeloma or diffuse large B-cell lymphoma that actually can be effective in CLL, which is chronic lymphocytic leukemia, but isn't very commonly used to treat people with CLL. At my institution, over 10 years ago, some investigators that were working in this area at the time started a research study to treat people with CLL before they met the traditional need for treatment. So for anyone that's less familiar with CLL, people are observed until they develop problems like really enlarged lymph nodes or low blood counts that mean they need to start a treatment. So these are people with a high-risk biologic feature to their CLL, meaning they will likely need treatment in the next few years, but who didn't strictly need treatment yet, who enrolled in the study to take lenalidomide, which is not usually standardly used to treat CLL, although it has been well studied in CLL. The original study, when it started 13 years ago, was to look at differences in antibody response to pneumococcal pneumonia vaccine to see if we could improve the immune system of people with CLL by giving them this drug. Turns out that that was not the case in the way we tested it in the study. However, we've had people taking lenalidomide for many years now, and so we wanted to make we shared with the scientific community how everybody who took the drug in the study did and kind of like the impact on their risk for other infections and other types of cancer. And you know, the risk of both of things has increased in people living with CLL. So we found that there was a group of people who had been on lenalidomide a very long time, including two people that were on it nine in 10 years. The results in terms of CLL control are quite good, although you have to think about the context of this being a trial for treatment or for people that didn't need treatment yet or wouldn't need standard indications for treatment. So it did actually control CLL for many years in some cases. And the really exciting findings we had is that it didn't seem to be a high risk of other forms of cancer. So there were a lot of people who developed non-melanoma skin cancers which were treated. And then a couple of people who developed other cancers, we had one melanoma skin cancer that was removed for someone. One person developed lung cancer and one person developed a skin cancer that actually spread to some lymph nodes. But we didn't see other blood cancers or some of the other cancers we worry about with treatment with lenalidomide. We also found that people who had been on the medication lenalidomide longer actually had a lower incidence of severe infections. So those are ones that led to medical care like hospitalization or more severe illness. So not like colds people get but more medically important illnesses. And found that the rate of infection in people who are on the drug longer was actually was low. So this certainly supports that taking lenalidomide long term doesn't really dramatically increase the risk of other cancers or infections beyond what we'd expect and that it's safe for long term use. So I think this really opens up a lot of pathways for investigation for use of lenalidomide Not only in this like early intervention setting which is before people need standard treatment but also as a maintenance after other treatments where it's been studied and other strategies to help people take this. And this was a relatively low dose of lenalidomide. So it's certainly supporting future investigation of lenalidomide in CLL.